TREATMENT OF METASTATIC PROSTATE CANCER

The traditional definition of “metastatic ” prostate cancer refers to disease stage and traditionally has included only patients with widespread osteoblastic or soft tissue metastases (clinical or pathologic stage Tany Nany M1, D2); it does not take into account the pathogenicity of the cancer or the risk of metastasis. Current evidence indicates that this definition should be broadened to include patients with a substantial risk of disease progression and death from prostate cancer, as well as those with traditional stage D-2 disease. Because many patients with T-3 disease or local lymph node metastases progress to distant metastases, the concept of metastatic or advanced prostate cancer should also include stages C and D-1 (Tany N-1 to N-3, T-3 and T-4). Furthermore, based on the widespread use of prostate-specific antigen (PSA) level as an early indicator of treatment outcome, many men treated for clinically localized disease will progress i.e. “PSA-only recurrence ” and, depending on their age and general health, should be included in the advanced stage category. Furthermore, using prognostic marker modeling with PSA, tumor grade and other factors, recurrences can be predicted even earlier in many cases. This is particularly significant in light of recent clinical data indicating that early androgen ablation therapy in patients with advanced (M-0, N-1 or M-1) prostate cancer delays dis-ease progression and improves survival relative to outcomes seen with delayed therapy